NPIMap

Organization Active NPI

Dental Office 300 Memorial Drive LLC

  • General Practice Dentistry
  • Crystal Lake, IL
National Provider Identifier
1669548830
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL OFFICE 300 MEMORIAL DRIVE LLC
Practice address
300 Memorial Dr Ste 400
Crystal Lake, IL 60014-6273
Phone
(815) 459-8127
Fax
(815) 459-8427
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William E. McNerney, D.D.S.NPI 1235205550
Title
Member
Phone
(815) 459-8127

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

300 Memorial Dr Ste 400
Crystal Lake, IL 60014-6273

Mailing address

300 Memorial Dr Ste 400
Crystal Lake, IL 60014-6273
Phone (815) 459-8127

Other names 1

  • McNerney & Wenzon Dental Other name

National Provider Directory

National Provider Directory

Locations

300 Memorial Dr
Ste 400
Crystal Lake, IL 60014
Phone (815) 459-8127

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669548830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MEMORIAL DR STE 400",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146273",
            "telephone_number": "815-459-8127",
            "fax_number": "815-459-8427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MEMORIAL DR STE 400",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146273",
            "telephone_number": "815-459-8127",
            "fax_number": "815-459-8427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL OFFICE 300 MEMORIAL DRIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCNERNEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "815-459-8127",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McNerney & Wenzon Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.